USPTO Patents Application 10804285

PTO/SB/06 (08-03)
Approved for use through 7/31/2006. 0MB 0651-0032
. ' U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995. no persons are required to^espond to a collection of information unless it displays a valid 0MB controt number.

PATENT APPLICATION FEE DETERMINATION RECORD

Substitute for Form PTO-875

CLAIMS AS FILED - PART I

(Column 1) (Column 2)

FOR

NUMBER FILED

NUMBER EXTRA

BASIC FEE
(37 CFR 1.16(a))

TOTAL CLAIMS
(37 CFR 1.16(c))

minus 20 =

INDEPENDENT CLAIMS
(37 CFR 1.16(b))

minus 3 =

MULTIPLE DEPENDENT CLAIM PRESENT (37 CFR 1.16(d))

' If the difference in column 1 is less than zero, enter "0" in column 2.
CLAIMS AS AMENDED - PART II

(Column 1) (Column 2) (Columns)

OMENTA

CLAIMS
REMAINING

AFTER
AMENDMENT

HIGHEST
NUMBER
PREVIOUSLY
PAID FOR

PRESENT
EXTRA

Total

(37 CFR 1.16(c))

Minus

"cut

UJ

Independent

(37 CFR 1.16(b))

Minus

*♦* ^

<

FIRST PRESENTATfON OF MULTIPLE DEPENDENT CLWM (37 CFR 1 .16(d))

(Column 1)

(Column 2)

(Column 3)

DMENT B

CLAIMS
REMAINING

AFTER
AMENDMENT

HIGHEST
NUMBER
PREVIOUSLY
PAID FOR

PRESENT
EXTRA

Total

(37 CFR 1.16(c))

♦

Minus

1EN

Independent

(37 CFR 1.16(b))

Minus

**♦

<

FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1 .16(d))

(Column 1)

(Column 2)

(Column 3)

DMENT C

CLAIMS
REMAINING

AFTER
AMENDMENT

HIGHEST
NUMBER
PREVIOUSLY
PAID FOR

PRESENT
EXTRA

Total

(37 CFR 1.16(c))

Minus

**

1EN

Independent

(37 CFR 1.16(b))

Minus

***

s

<

FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1 .16(d))

SMALL ENTITY

OR

OTHER THAN
SMALL ENTITY

* If the entry in column 1 is less than the entry in column 2, write "0" in column 3.
** If the "Highest Number Previously Paid For IN THIS SPACE is less than 20, enter "20".
'** If the "Highest Number Previously Paid For" IN THIS SPACE is less than 3, enter "3".

The "Highest Number Previously Paid For^ (Total or Independent) is the highest number found in the appr

RATE

FEE

RATE

FEE

$

OR

$

X $ =

OR

X $ =

X $

OR

X $ =

+ $

OR

+ $

TOTAL

OR

TOTAL

SMALL ENTITY

OR

OTHER THAN
SMALL ENTITY

RATE

ADDI-

1 lUlNAL

FEE

RATE

ADDI-
TIONAL
FEE

X $ =

^OR

X $ =

X $

OR

X $

^

+ $

OR

+ $

TOTAL
ADD'L FEE

OR

TOTAL
ADD'L FEE

RATE

ADDI-
TIONAL
FEE

RATE

ADDI-
TIONAL
FEE

X $

OR

X $ =

X $ =

OR

X $ =

+ $

OR

+ $

TOTAL
ADD'L FEE

OR

TOTAL
ADD'L FEE

RATE

ADDI-
TIONAL
FEE

RATE

ADDI-
TIONAL
FEE

X $

OR

X $ =

X $

OR

X $

+ $

OR

+ $

TOTAL
ADD'L FEE

OR

TOTAL
ADD'L FEE

ipriate

box in column 1.

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